Burnout prevalence and correlates amongst Colombian dental students: the STRESSCODE study.

INTRODUCTION: Accumulating evidence amongst dental students indicates an alarming prevalence of stress, which can precipitate the development of burnout--a state of mental or physical exhaustion and disengagement. Understanding individual and educational correlates of burnout is necessary for its prevention. The aims of this study were to determine the prevalence of burnout amongst a large sample of Colombian dental undergraduates and investigate its psychosocial and educational correlates. MATERIALS AND METHODS: Survey data collected from 5647 students participating in the Stress in Colombian Dental Education study were used for this analysis. Burnout was measured using the Maslach Burnout Inventory-Student Survey (MBI-SS). Covariates included participants' socio-demographic characteristics and perceived stress, as well as educational environment factors. Descriptive, bivariate and multivariate methods based on multilevel mixed-effects logistic regression modelling were used for data analysis. RESULTS: Seven per cent of the students surveyed met the criteria for burnout. The prevalence of burnout was higher amongst upper classes, older and married students, those who reported not having passed all required courses and not having dentistry as their first career choice, as well as students in public institutions and those with large class sizes. Moreover, students' perceived stress in the domains of workload and self-efficacy was significantly and positively associated with burnout. CONCLUSIONS: Both personal and educational environment characteristics were found to be associated with burnout. Irrespective of these factors, students' perceived stress with regard to workload and self-efficacy was a strong influence on burnout and its alleviation may be a promising avenue to prevent psychological morbidity.

The extent of food advertising to children on Greek television: focus on foods potentially detrimental to oral health.

OBJECTIVES: To investigate the extent and nature of food advertising to children on Greek television, focusing on the adverts for foods with potential harmful effects on oral health, and to examine the persuasive marketing techniques used to promote food products. METHODS: Advertisements broadcast on six TV-channels during children's peak viewing times on two weekdays and two weekend days in the period May-June 2010 were recorded (166.7 hours). Each advertisement was coded according to: date, day, length, type of program in which the ad appeared, type of product advertised and promotional technique used. Food advertisements were subdivided according to their sugar and/or acid content as potentially harmful or non-harmful to teeth. RESULTS: Food advertisements had an average frequency of 8.0 per hour during children's peak viewing times with highest frequency (11.4 per hour) on weekends during child-focused programs. Of all advertisements, 1330 (26.7%) were for foods, and 595 (44.7%) of these deemed to be potentially harmful to teeth. The most commonly advertised food product during children's programs was confectionery, 80 (27.7%). Of food advertisements, 199 (15.0%) used at least one of the promotional techniques likely to appeal to children. Advertisements for foods potentially harmful for teeth were more likely to be shown during child-focused programs (OR 2.92, 95% CI 2.04-4.16) and to promise a free gift with purchase (OR 35.43, 95% CI 10.83-115.88). CONCLUSION: Children in Greece are exposed to a large volume of advertisements for unhealthy foods and drinks, which intensively use persuasive techniques proved to affect children's food preferences and consumption. Our study provides evidence that could support advocacy and interventions for the regulation of food advertising.

Cervical dentin hypersensitivity: a cross-sectional investigation in Athens, Greece.

The purpose of this study was to identify the prevalence of cervical dentin hypersensitivity in a cross-sectional investigation of Greek adults. Seven hundred and sixty-seven subjects were examined. Participants were patients processed for first examination in the Clinic of Oral Diagnosis and Radiology at the Faculty of Dentistry, University of Athens. The evaluation of hypersensitivity was performed using two methods: for each tooth, the response to a) tactile stimulus and b) air-blast stimulus was measured. Additional factors such as smoking habits, oral health behaviour, consumption of acidic foods, type of toothbrush, daily use of fluoride solution and of desensitising toothpaste, gingival recession and non-carious cervical lesions were recorded and evaluated as causative factors. Descriptive statistics on the demographics of the study sample, of oral health behaviour characteristics and of oral examination findings were performed. Comparisons of these characteristics in the presence or absence of hypersensitivity were conducted with the chi-square test. Data were further analysed using multiple logistic regression modelling. Among study participants, 21·3% had at least one cervical dentin hypersensitivity reaction to the tactile stimulus, and 38·6%, to the air-blast stimulus. Multivariate analysis detected association of the hypersensitivity in tactile or air-blast stimulus with the non-carious lesions and with the gingival recessions. Additionally, a relation between hypersensitivity and air-blast stimulus with gender (female) was found. There was no association between the hypersensitivity in both of the stimuli and the level of education, smoking, consumption of acidic foods, type of toothbrush and daily use of fluoride solution or desensitising toothpaste. The overall prevalence of cervical dentin hypersensitivity in the adult population in Athens ranged from 21·3% to 38·6% depending on the type of stimuli. Cervical non-carious lesions and gingival recessions were determined as significant predictors of dentin hypersensitivity.

Perceived sources of stress amongst Chilean and Argentinean dental students.

INTRODUCTION: The prevalence of high levels of stress as well as its multilevel consequences is well documented amongst students in the health sciences, and particularly in dentistry. However, investigations of perceived stress amongst Spanish-speaking student groups are sparse. This study aimed to (i) describe the translation, adaptation and psychometric properties of a Spanish version of the Dental Environment Stressors questionnaire and (ii) to examine the perceived sources of stress and their associations with the students' study year and gender in two dental schools in Latin America. MATERIALS AND METHODS: All students officially registered in the dental schools of the University of San Sebastian (USS) in Chile and the Catholic University of Cordoba (CUC) in Argentina were invited to participate in the study. The DES30 questionnaire was adapted in Spanish using translation/back-translation, an expert bilingual committee, and consensus building. Cronbach's alpha was used to measure the instrument's internal consistency, and iterated principal factor analysis with promax rotation was employed to explore its underlying factor structure. Descriptive, bivariate and multivariate methods were used to examine the patterns of association between individual stressors, factor scores and students' characteristics. RESULTS: Three hundred and four students comprised the study's analytical sample, with two-thirds of those being female. The DES30-Sp demonstrated good internal consistency (Cronbach's α = 0.89). A four-factor solution emerged and included 'academic workload', 'clinical training', 'time constraints' and 'self-efficacy beliefs' factors. 'Fear of failing a course or a year', 'examinations and grades' and 'lack of time for relaxation' were amongst the top individual-item stressors reported by students in both schools. Amongst this group of undergraduate dental students, those in Argentina, in higher study year, and females reported higher perceived stress. CONCLUSIONS: Increased workload, time constraints and some aspects of clinical training were the top stressors of approximately 300 Chilean and Argentinean dental undergraduates. Some variations between schools, males and females and study years were noted. The Spanish version of the DES30 questionnaire performed well, but future studies should evaluate the instrument's properties in larger and more diverse dental student populations.

Dental caries and dental developmental defects as adverse effects of antineoplastic treatment in childhood cancer survivors.

PURPOSE: To evaluate the prevalence of dental caries and dental developmental defects (DDD) in childhood cancer survivors (CCS) and identify disease and treatment-related risk factors. METHODS: CCS aged up to 21 years, diagnosed with a malignancy before the age of 10 years and in remission for at least one year were included. Data were collected from patients' medical records and through a clinical examination where presence of dental caries and prevalence of DDD were recorded. Fisher's exact test was used to assess possible correlations and multivariate regression analysis to determine risk factors for defect development. RESULTS: Seventy CCS with a mean chronological age of 11.2 years at the time of examination, mean age at cancer diagnosis of 4.17 years, and a mean post-treatment follow-up time of 5.48 years were included. Mean DMFT/dmft was 1.31, with 29% of survivors presenting with at least one carious lesion. Younger patients on the day of examination and patients treated with higher radiation dose, showed significantly higher prevalence of dental caries. The prevalence of DDD was 59%, with demarcated opacities being the defect most commonly observed (40%). Age at dental examination, diagnosis, age at diagnosis, and time that have elapsed since the end of treatment were the factors significantly affecting its prevalence. Regression analysis revealed that age at examination was the only factor significantly associated with the presence of coronal defects. CONCLUSION: A great number of CCS presented with at least one carious lesion or a DDD, with the prevalence being significantly associated with various disease-specific characteristics, but age at dental examination the only significant predictor.

Caries prevalence of 5, 12 and 15-year-old Greek children: a national pathfinder survey.

AIM: To study the caries prevalence and caries experience of 5, 12 and 15-year-old children in Greece and evaluate how the disease pattern is related to their sociodemographic parameters. METHODS: A stratified cluster sample of 1209, 1224 and 1257 of five, twelve and fifteen-year-old Greek children were randomly selected according to WHO guidelines for national pathfinder surveys and examined for dental caries, according to the BASCD criteria and standards. d3mft, D3MFT and their components, as well as d3mfs, D3MFS, Care Index (CI) and SiC were recorded and related to the demographic data collected concerning age, gender, counties, urban/rural areas and parents' educational status. RESULTS: Dental caries varied considerably between the different districts, with a mean dmft/DMFT value for each age group being 1.77, 2.05 and 3.19 respectively, while 64%, 37% and 29% of them, were with no obvious dentinal caries. Children living in rural areas demonstrated significantly higher dmft/DMFT values and less dental restorative care (CI), whereas children with fathers of a higher educational level showed significantly lower dmft/DMFT values. The significant caries (SIC) index value for the three age groups was 5.01, 4.83 and 7.07 respectively. Posterior occlusal surfaces of the permanent teeth presented most of the caries in the 12 (68%) and 15-year-old group (78%). CONCLUSIONS: Despite the decrease in the prevalence of caries in Greek children disparities remain. Children in rural areas and children with less educated parents had more caries and more untreated caries. All the above call for immediate intervention with comprehensive preventive programs and better geographic targeting of the dental services at a national level including targeted prevention of pit and fissure sealants on posterior permanent molars.

Stress and burnout in postgraduate dental education.

INTRODUCTION: High levels of stress and burnout have been documented among dental students and practicing dentists, but evidence among dental residents and postgraduate students is lacking. MATERIALS AND METHODS: Ninety-nine postgraduate students enrolled in clinical, non-clinical and PhD programmes in the Athens University School of Dentistry completed the Graduate Dental Environment Stress (GDES) questionnaire and the Maslach Burnout Inventory. Perceived stress was measured in two domains, academic (GDES-A) and clinical (GDES-C) and burnout was measured using the scales of emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). Analyses relied on descriptive, univariate and multivariate methods based on ANOVA and generalised linear models. RESULTS: Participants' mean age was 30 years; two-thirds were women and practised dentistry independently of their graduate studies. Residents in clinical programmes reported significantly higher levels of perceived stress compared to non-clinical and PhD students (P<0.05). There were no gender differences in perceived stress. Forty per cent of respondents were burnout 'cases' on the EE scale, while this proportion was 38% for reduced PA and smaller, 13% for DP. Perceived stress was positively correlated with all burnout dimensions, whereas independent dental practice and higher age had a protective effect. CONCLUSIONS: High rates of burnout manifestations were detected among this sample of Greek postgraduate dental students. Perceived stress correlated with burnout and was more pronounced among those enrolled in clinical residency compared to non-clinical and PhD programmes.

Oral hygiene and periodontal condition of 12- and 15-year-old Greek adolescents. Socio-behavioural risk indicators, self- rated oral health and changes in 10 years.

AIM: To investigate oral hygiene and periodontal status of 12- and 15-year-old Greek adolescents in relation to socio- demographic and behavioural indicators and identify national trends. MATERIALS AND METHODS: In a stratified cluster sample of 2,478 participants, the Simplified Debris Index (DI-S) and the Community Periodontal Index (CPI) were calculated. Socio- demographic/behavioural data were collected through structured questionnaires. Multivariate ordinary regression examined the effect of socio-behavioural indicators on oral hygiene and periodontal conditions. RESULTS: 51.7% of the 12-year-olds and 56.9% of the 15- year-olds had fair and good oral hygiene, respectively. Approximately 30% of the adolescents had healthy periodontium. Bleeding on probing was detected in 23.6% and 21.6% of the 12- and the 15-year-olds, accordingly. Calculus was found in 46.2% and 44.3% of the 12- and the 15-year-old groups, correspondingly. The prevalence of periodontal pockets ?4mm was 3.2%. Significantly higher DI-S scores were found among 12-year-olds who were males, had lower educated mothers or did not use dental floss and among adolescents who brushed their teeth

An exploratory study on cultural variations in oral health attitudes, behaviour and values of freshman (first-year) dental students.

OBJECTIVE: To identify similarities and differences in oral health attitudes, behaviour and values among freshman dental students. DESIGN: Cross-cultural survey of dental students. SETTING: 18 cultural areas. PARTICIPANTS AND METHODS: 904 first-year dental students completed the Hiroshima University-Dental Behavioural Inventory (HU-DBI) translated into their own languages. Individual areas were clustered by similarity in responses to the questions. RESULTS: The first group displayed an 'occidental-culture orientation' with the exception of Brazil (Cluster 1 comprised: Australia, United Kingdom, Ireland, Belgium and Brazil, Cluster 2: Germany, Italy, Finland and France). The second group displayed an 'oriental-cultural orientation' with the exception of Greece and Israel (Cluster 3 comprised: China and Indonesia, and Cluster 4: Japan, Korea, Israel, Hong Kong, Malaysia, Thailand and Greece). Australia and United Kingdom were the countries that were most alike. Ireland was the 'neighbour' to these countries. Greece and Malaysia had similar patterns of oral health behaviour although geographic conditions are very different. Although it was considered that in Hong Kong, occidental nations have affected the development of education, it remained in the oriental-culture group. Comparison with the data from the occidentals indicates that a higher percentage of the orientals put off going to the dentist until they have toothache (p < 0.001). Only a small proportion of the occidentals (8%) reported a perception of inevitability in having false teeth, whereas 33% of the orientals held this fatalistic belief (p = 0.001). CONCLUSIONS: Grouping the countries into key cultural orientations and international clusters yielded plausible results, using the HU-DBI.

Risk factors for injuries among the elderly in Greece.

Extrinsic and intrinsic risk factors for injuries among the elderly in Greece were investigated in a hospital based case-control study. Cases were 200 elderly persons, residents of the Greater Athens area, who contacted the "Laiko" University Hospital for accident-related injuries, during a 10-month period, whereas the control series comprised 385 elderly who, during the same period, contacted the same hospital for non-injury related medical reasons. Data were analyzed by modeling through multiple logistic regression. Statistically significant associations were found for smoking vs non-smoking [odds ratio (OR) 2.40; 95% confidence interval (CI) 1.22-4.70], moderate use of alcoholic beverages vs non use (OR 0.37; CI 0.23-0.61) and house safety score (OR 0.72; CI 0.56-0.93 for an improvement by 1 unit). Non statistically significant positive associations were noted with history of previous hospitalizations for injury, chronic central nervous system conditions, defective hearing, refractive eye disorders, current use of psychoactive drugs, excessive use of alcoholic beverages, other than ground floor residency, cohabitation with fewer members and other than currently married status. Restricted activity was assessed in subsamples of cases and controls and was associated with somewhat reduced risk for injury (OR for one unit increase in a 10 unit modified Groningen activity scale is 1.06; CI 0.99 to 1.13). Overall, these results suggest that there is a constellation of plausible risk factors for injuries among the elderly.

Determinants of stillbirth mortality in Greece.

A population-based case-control study of the determinants of stillbirths was conducted in Greece from 1989 to 1991. All reported stillbirths after 28 weeks of pregnancy (N = 2,006) during the three year study period comprised the case group. The control group derived from random sampling of 10% of all livebirths in Greece, during the same period (N = 30,705). The data were analysed by modelling through multiple logistic regression. The adjusted relative risk of stillbirth was significantly higher for males compared to females. A statistically significant monotonic increase in relative risk was observed with shorter gestational age, low maternal education, and older maternal age. Birthweight and parity showed a statistically significant U-shaped association with stillbirth risk, with a higher risk being observed among both low and high birthweight deliveries, as well as among primiparous or multiparous (4+) mothers. Positive associations of stillbirth with multiple births, out-of-wedlock marriage and non-Greek-orthodox maternal religion were noted in crude analyses, but these associations almost disappeared in logistic regression model. Maternal urban or rural residence showed no relation to risk. Overall, the prospective risk of stillbirth after the 24th week of gestation in Greece has been estimated to be higher than that in Japan (a more developed country) with more than 40% of stillbirths occurring after the 36th week of pregnancy.

Association of cemento-enamel junction--alveolar bone crest distance and proximal caries in primary molars.

The present cross-sectional investigation examined the relationship between proximal caries/defective restorations, dental plaque and gingival indices and the distance of the cemento-enamel junction to the alveolar bone crest (CEJ-ABC). Three hundred and eight children aged 7 years were examined. Proximal caries and defective restorations were diagnosed in bite-wing radiographs. CEJ-ABC was measured on radiographs using a Boley gauge. Dental plaque and gingivitis were recorded clinically by their presence or absence. Multiple linear regression was used for the statistical analyses. The results showed significantly association between the proximal caries index and CEJ-ABC. Dental plaque, gingivitis and gender were not associated significantly with CEJ-ABC.

Oral hygiene and periodontal status of 12 and 15-year-old Greek adolescents. A national pathfinder survey.

AIM: To investigate oral hygiene and periodontal status of 12- and 15-year old Greek adolescents, in relation to sociodemographic and behavioural parameters. METHODS: A stratified cluster sample of 1,224 12-year old and 1,257 15-year old adolescents of Greek nationality were selected and examined by calibrated examiners. Periodontal and oral hygiene status were assessed using the Community Periodontal Index (CPI) and the simplified Debris Index (DIs) respectively. The socio-demographic and behavioural data collected included region, location, gender, parental educational level, tooth brushing frequency and reason for dental attendance. RESULTS: The majority of adolescents aged 12 (75.0%) and 15-years (61.4%) had fair oral hygiene levels. The most frequently observed condition in both ages was calculus with or without bleeding (42.8% in the younger and 53.3% in the older age group). Bleeding on probing was found in 41.5% of the 12-year-olds and in 30.0% of the 15-year-olds. The occurrence of shallow and/ or deep periodontal pockets was very low (0.2%). Multivariable modelling revealed that gender, location and tooth brushing frequency were strongly associated with oral hygiene status in both ages; girls, those living in urban areas and brushing teeth more frequently had significantly lower DI-s. Tooth brushing frequency was also associated with periodontal status in both ages, while living in urban areas was associated with better periodontal health only in the 15-year-olds. CONCLUSIONS: The study demonstrated that oral hygiene conditions among Greek children and adolescents are not satisfactory and that the occurrence of gingivitis is high. More efforts on oral health education and oral hygiene instruction are needed to improve their periodontal and oral hygiene status.

Socio-behavioural factors influencing oral health of 12 and 15 year old Greek adolescents. A national pathfinder survey.

AIM: To estimate the frequency in use of oral health services, oral health self-assessment, oral hygiene practices of 12- and 15-year-old Greek children and adolescents, to investigate possible influences of these factors and other socio-demographic parameters on oral health. METHODS: A stratified cluster sample of 1224 12 year old and 1257 15 year old children and adolescents of Greek nationality were selected and examined by calibrated examiners. Clinical examination included recording of caries according to the British association for the study of community dentistry diagnostic criteria, while oral hygiene and periodontal status were assessed by means of the simplified debris and the community periodontal index. Subjects were interviewed to answer questions on socio-behavioural risk factors through a structured questionnaire. The student's t-test and ANOVA were used for statistical evaluation of the means and the chi-square test was applied for statistical comparison of the proportions. Multiple linear regression analysis was performed to assess the statistical association between variables. RESULTS: Caries experience and untreated caries were significantly higher among children and adolescents who visited the dentist only when in pain or for restoring a tooth, compared to those visiting for check-ups or prevention and having more frequent application of topical fluorides. Tooth brushing, at least twice a day, and flossing were significantly associated with periodontal and oral hygiene status, but not with caries presence. The multivariate analysis revealed that parental educational status and reason for visiting a dentist were strong determinants for caries experience and oral hygiene status but not for periodontal health of children and adolescents. CONCLUSIONS: This study has identified several socio-demographic and behavioural determinants for dental caries, oral hygiene and periodontal health of Greek children and adolescents.

Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets.

OBJECTIVES: To explore whether the use of self-ligating brackets is associated with better values for periodontal indices because of the lack of elastomeric modules and concomitantly, reduced availability of retentive sites for microbial colonization and plaque accumulation. SETTING AND SAMPLE POPULATION: Private practice of the first author. Patients were selected using the following inclusion criteria: age range 12-17 years, fixed appliances on both arches, aligned mandibular arch, and absence of oral habits and anterior crossbites. MATERIALS AND METHODS: Prospective cohort investigation. Participants were grouped for bracket type, thus 50 patients formed the conventional bracket cohort and 50 patients the self-ligating bracket cohort. Both cohorts were followed with the purpose to examine periodontal status. Average length of follow-up was 18 months. This time period was considered adequate for a proportion of study participants to experience the outcome of interest. Outcome variables were plaque index, gingival index, calculus index, and probing depth for the two bracket cohorts. RESULTS: No difference was found in the indices recorded between the two bracket cohorts studied. CONCLUSION: Under the conditions as applied in this study, the self-ligating brackets do not have an advantage over conventional brackets with respect to the periodontal status of the mandibular anterior teeth.

Coffee and ovarian cancer.

Ninety-two women with common epithelial tumors of the ovary and 105 comparison women admitted for various orthopedic conditions were interviewed regarding demographic, socio-economic and biomedical characteristics, including their use of coffee and tobacco. There was no association between tobacco smoking and ovarian cancer. However a statistically significant trend association was noted between coffee drinking and ovarian cancer (p approximately 0.03). The association could not be explained in terms of any other variable included in the present study. The relative risk for women drinking two or more cups of coffee per day was 2.2 with 95% confidence limits 1.0-4.8. Several descriptive epidemiologic data are compatible with a causal association between coffee and ovarian cancer.

Obesity, serum cholesterol, and estrogens in premenopausal women.

Creatinine-adjusted levels of estrone, estradiol, and estriol were determined in luteal phase urine specimens of 200 premenopausal women from rural areas of Greece. The relation of each estrogen to height, weight, obesity index, and serum cholesterol was studied by multiple regression, controlling for age, age at menarche, and ovulation status (ovulation, anovulation, undetermined). No consistent relation between any of the somatometric variables and any of the urine estrogens emerged from the statistical analysis, but among older women (30-40 years old) both estrone and estradiol were positively associated with serum cholesterol (p less than 0.05). The data provide no support for the hypothesis that the relationship between body weight and breast cancer risk is mediated through an influence of body weight on estrogen levels--at least in premenopausal women. On the other hand the data on serum cholesterol levels are consonant with the idea that qualitative aspects of nutrition may affect breast cancer risk among older (e.g., postmenopausal) women.

The AIDS profile in a low risk country: the central role of bisexual men.

BACKGROUND: Policies and measures for the prevention of human immunodeficiency virus Type 1 (HIV-1) transmission require adequate information about the risk profile of AIDS which is time-, place- and population-dependent. We have studied the risk factors for AIDS among men in Greece, a country with relatively low incidence of AIDS. METHODS: A case-control study of all male patients with incident disease, who have been diagnosed in the major university-affiliated, AIDS Unit from February 1995 through August 1997 was conducted in Athens, Greece, a country with relatively low incidence of AIDS. Eighty-three AIDS patients were enrolled and an equal number of orthopaedic patients as controls. All interviews were conducted by the same physician and took place in the hospital. RESULTS: There were no differences among heterosexual men with AIDS, homo- or bi-sexual men with AIDS, and controls with respect to any socio-economic variable. The odds ratio for AIDS among homo- or bi-sexual men, in comparison with heterosexual men, was 51.5 (95% confidence intervals 21.6-122.7). Blood transfusion, intravenous drug abuse and haemophilia were less important risk factors for AIDS in this study. Condom use was generally very low and there was a tendency for lesser use among men at highest risk for HIV transmission, that is, those with a preference for receptive anal intercourse. CONCLUSIONS: AIDS among men in Greece is mainly driven by homosexual behaviour, but the relatively high proportion of bisexual men and the relatively low frequency of condom use are warning signs for the potential of the epidemic to expand in the future. The relatively low incidence of AIDS in Greece, in comparison with other European populations, may be due to a phase difference in the epidemic, but it could also be due to the traditional role separation of homosexuals in this geographical area, and the easy accessibility of disposable syringes and needles in Greece.

Hair dyes, analgesics, tranquilizers and perineal talc application as risk factors for ovarian cancer.

In a hospital-based case-control study of ovarian cancer conducted in Athens (1989-1991), 189 women with histologically confirmed common malignant epithelial tumors of the ovary were compared with 200 hospital visitor controls. All interviews were conducted by personal interview in the 2 participating hospitals and the data were analyzed by modelling through logistic regression, controlling for demographic and reproductive variables. Tranquilizing and hypnotic drugs (mostly diazepam) were not associated with risk of ovarian cancer: the adjusted relative risk (RR) and 95% confidence interval (CI) were 0.96 (0.57 to 1.63), whereas use of analgesics (mostly salicylates) was associated with significantly reduced risk of the disease (RR 0.51; CI 0.26 to 1.02). There was no evidence that perineal application of talc was associated with increased risk (RR 1.05; CI 0.28 to 3.98) but the frequency of reporting talc use was low in the study population. There was a statistically significant (p for trend 0.007) and a dose-dependent association between hair dyeing and risk of ovarian cancer. Compared to never-users, women dyeing their hair up to 4 times per year had a relative risk of 1.74 (0.91 to 3.32) whereas those dyeing their hair 5 or more times per year had a relative risk of 2.16 (1.19 to 3.89).